Vertebrae are the building blocks of the spine, and in between each vertebrae lies important discs. These discs serve as cushions to absorb shock and minimize the impact of movement on the spine. Spinal discs have been compared to jelly doughnuts, with a soft central portion and a solid surrounding area. In the diagram below, the nucleus pulposus would be considered the jelly and the annulus fibrosus would be considered the doughnut. When you have a herniated disc, that “jelly” ruptures through the annulus fibrosus and compresses the spinal nerves, causing inflammation and pain. Herniated discs, also referred to as slipped discs, are one of the most common causes of back pain and discomfort in adults. Most of the time, patients do not even know what a herniated disc is – they just know they have it, and they are in excruciating pain.
First and foremost, if you are having excruciating back pain, it is best to get checked out by a physician before starting any self-diagnoses or medication. But how do you know if you have a herniated disc or just back pain? The most common location for a herniated disc is in a disc in the lower back, just above the hips. Because this area is constantly absorbing the weight of the upper body, it makes for an easier target for conditions like herniated discs. When you have a herniated disc, it is common to feel pain radiating down to the hips, buttocks, and legs, also known as sciatica. Some other symptoms of a herniated disc include numbness, muscle weakness, muscle spasms, and tingling sensations. Sometimes, even coughing and sneezing can aggravate your symptoms because they put pressure on the pinched nerves.
When you go to a physician for an official diagnosis, they will do a physical exam involving checking for pain points and back tenderness. Usually, the physical exam is the only one necessary to confirm a herniated disc, but the physician may want to do further testing to rule out other sources of pain. Those other tests may include x-rays, myelogram, CT scan, MRI, or electromyogram (EMG) and nerve conduction studies (NCS).
The lower back is highly active at all times. Whether you’re sitting, running, bending, or lifting, your lower back is taking on the most weight and pressure. As we age, our discs tend to degenerate and lose their cushioning, which is a large cause of a herniated disc. While age is a large cause of this, slipped discs can also occur due to certain motions. A disc can slip out of places while you are twisting or turning or lifting very large and heavy objects. Those who are overweight are at an increased risk for herniated discs because of the extra weight the vertebrae must support.
If left untreated, a herniated disc can lead to permanent nerve damage and in rare cases can cut off nerve pulses to the cauda equina nerves in your lower back and legs. When this happens, you could lose bowel or bladder control. Another long-term complication is known as saddle anesthesia. With this, the herniated disc compresses nerves and causes you to lose sensation in your inner thighs, the back of the legs, and around the rectum.
Treatments for herniated discs can range from conservative to surgical. Most of the time, the treatment is nonsurgical, but depending on the level of discomfort and how far the disk has slipped out of place, a surgery may be beneficial. A process of trial and error is often used to find the right combination of treatment options at once.
- Physical therapy: Physical therapy helps educate patients on good body mechanics, which helps prevent excessive wear and tear on the discs. Pain can be relieved through stretches and exercises that strengthen the back and the surrounding muscles. Staying active during the pain or discomfort of a herniated disc is important to avoid muscle weakness and joint stiffness.
- Muscle-relaxant medications: Your physician may prescribe you muscle relaxers to relieve muscle spasms.
- Pain/anti-inflammatory medications: Taking over-the-counter pain relievers and avoiding lifting heavy things can help. Also, taking pain relievers can allow you to do more with physical therapy.
- Epidural steroid injections: ESIs can help decrease the inflammation directly at the painful nerve, therefore reducing pain. For more about epidural steroid injections, read our blog.
- Ice and heat therapy: on and off ice and heat packs can help relieve your pain. Heat therapy is good for muscle spasms and trigger points that can be caused by a herniated disc. Plus, heat helps blood flow and oxygen supply to the treated area. Ice therapy is good for inflammation and can reduce the swelling around the irritated or compressed spinal nerve.
More often than not, patients experience pain relief from the nonsurgical treatments. If the nonsurgical treatments are not effective for pain relief, you should ask your physician about surgery options.
- Lumbar decompression surgery: During this surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space.
- Microdiscectomy: During this minimally invasive procedure, a surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve column.
- Laminotomy: The surgeon will make an opening in the vertebral arch to relieve pressure on your nerve roots.
If you’re experiencing back pain and it’s affecting your everyday activities, it is best to check with a physician right away.